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Using compliments to measure quality

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Recording positive feedback can boost staff morale and help improve service quality 

In this article…

  • Why it is important to collect positive feedback;
  • How a trust developed a new system for collecting compliments;
  • How collecting compliments can help measure service improvement 



Sally Ashton is project lead for the productive mental health ward programme, 2Gether Foundation Trust, Gloucester. 



Ashton S (2011) Using compliments to measure quality. Nursing Times; 107: 7, early online publication.

Collecting positive feedback can increase nurses’ confidence, show improvements in performance and provide a baseline for measuring patient satisfaction. This article describes how nurses on a dementia assessment ward at a Gloucestershire trust designed, implemented and evaluated a new way of collecting compliments, changing staff attitudes to receiving feedback

Keywords: Complaints, Compliments, Service improvement

  • This article has been double-blind peer reviewed


5 key points

  1. Implementing a robust system for collecting compliments ensures positive feedback is accurately reflected
  2. Compliments can be offset by complaints to give a balanced view of a service
  3. Data collected can be used as a benchmark to measure services and improve staff awareness of quality issues;
  4. Collecting compliments can give a ward positive exposure within an organisation
  5. The method for collecting and recording compliments should be easy to use and sustain


The Department of Health (2009a) has said the NHS should to listen to complaints, and address them better. A study from the health service ombudsman – which examined 15,579 complaints made about the NHS in England in 2009/10 – also found trusts needed to “listen harder” to patient complaints(Parliamentary and Health Service Ombudsman, 2010). 

The experiences of nurses, along with other health care staff, are important when listening to and learning from service users about their experiences when receiving care (DH, 2009). The complaints system is, therefore, an important educational tool and not just a paper exercise.  

In 2009, policy changes affecting the way the NHS handles complaints came into effect, with the government introducing a single complaint system for health and adult social care services in England (DH, 2009). The DH offered guidance for trusts on producing patient information leaflets on the four Cs – comment, concern, complaint or compliment. This said the four Cs should be seen as an essential part of an organisation’s feedback mechanism, as an indicator of what is working, what is potentially problematic, how to prevent problems escalating and how to highlight opportunities for staff improvement (DH, 2009b). It encouraged organisations to consider comments and compliments about staff and services alongside each other to improve learning, responding and improving.

However, reviewing patient information leaflets from several trusts I found that only around 10% of the wording of a typical complaints information leaflet referred to compliments. The remainder of the text informed patients how to complain and who to complain to. This shows that, while systems exist for recording complaints, there are none for recording and reporting compliments, yet patient satisfaction is a key measure of patient experience. This article shows how a bottom-up, locally led innovation can help embed quality within an NHS ward setting (DH, 2008a).   


In 2010, 2Gether Foundation Trust’s complaints department set out to improve the collection, recording and reporting of compliments received for 2010-11. Trust staff often receive compliments by letter or card, verbally, or via a gift. They are thanked for the treatment, care and support they receive, or complimented on the environment, atmosphere, and cleanliness of the ward (McDonald, 2010). 

However, not all compliments at the trust were being recorded and sent to the complaints department or the patient advice and liaison service (PALS). This meant the number of compliments reported in the trust’s annual and quarterly reports was not a true reflection of the total number received.

Willow ward is the only dementia assessment ward at the trust’s Charlton Lane Hospital. It is important to capture feedback from service users with dementia, but verbal and written compliments are often limited due to levels of understanding, communication problems, and stage of illness (Allen, 2001).

In 2009, just 16 compliments were recorded for Willow ward, a monthly average of 1.33. The ward team was aware that verbal compliments were being received frequently, but there was no system for collecting these - the trust’s system for recording and reporting compliments relied on written evidence. Therefore, the total number of compliments received was inaccurate and did not reflect the service. Using the Productive Mental Health Ward framework (NHS Institute for Innovation and Improvement, 2008), ward staff trialled a new way of collecting compliments.

The project

A compliments grid was created based on themes from the complaints department annual report 2009-10. This recorded the number of compliments received, and the ways staff were thanked across the trust. We used the categories identified in the report to create a daily table on which ward staff tick the appropriate box when they receive a compliment.

Initially, the compliments grid was to be displayed as a wall calendar to present a week of compliments at a glance. However, the team found it more useful to have a daily grid stapled into the ward diary where they would see it several times a day. This helped act as a prompt to record compliments they received.

Completing the grid takes only seconds; it involves placing two ticks in the corresponding boxes for each compliment received - one tick shows who made the compliment and what it was about, and the second tick shows the type of compliment received. The daily grid can be used to record several compliments from one day, and the daily total. The grid is also stapled into the ward team diary so it can be seen regularly by ward staff. The compliments grid was trialled on Willow ward for one month in September 2010.


By the end of the month, the team had collected 30 compliments – around one a day. This was an increase of more than 28 recorded compliments a month – almost double the tally for the whole of the previous year (Figs 1 and 2).

Carers made the most compliments, followed by other family members, then patients. Most compliments were verbal rather than written or in the form of a gift, and the greatest proportion were about care and treatment. No complaints were received during the study period.


Willow ward’s team goal was to collect compliments more accurately and measure something meaningful. Staff found the compliments grid easy to use and to sustain. The ward clerk prints off and staples one grid per day into the ward team diary. She then tallies up the total for each month and feeds this back to the ward manager who forwards the data to the complaints manager.

While this is a small change towards improving quality, it has been locally led (DH, 2008b). Implementing the Productive Mental Health Ward programme (NHS Institute for Innovation and Improvement, 2008) gave the team the confidence to challenge the current process, and find a simple system that would work for them.

Collecting compliments in this way can be used as a benchmark to measure progress, give a ward positive exposure, and improve awareness of quality issues (DH, 2010). It is also without bias as anyone offering a compliment is unaware it is being recorded. There is no pressure to make a compliment verbally, or for ward staff to have to ask the person to put it in writing. 

The balance of offsetting compliments against complaints laid the foundations for a stronger customer focus and helped develop a ward culture that learns from feedback.


Collecting compliments is one example of a ward-based innovation for measuring and tracking feedback. It can show improvements in performance, and provide a baseline for measuring patient satisfaction. Collecting compliments shows a ward team how generating meaningful data can help drive continuous improvement. It also gives the team factual information to demonstrate whether they are achieving their goals, and shows the impact of displaying this data visually.

The project helped the team on Willow ward to understand their performance in terms of providing care, treatment and support to patients and carers. It also helped them to positively recognise the impact of their contribution to care in the ward setting, and the wider organisation. Two more wards have adopted the system, and the complaints department is considering introducing it trust wide.  

Box 1. Benefits of collecting compliments

Positive feedback:

  • Reduces ward staff stress levels and increases confidence;
  • Improves staff wellbeing;
  • Improves team working toward a shared goal;
  • Increases motivation from ward team to continue the initiative;
  • Allows patient and carer satisfaction with ward staff and services to be measured;
  • Offers a counterpoint to any complaints received.


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  • 1 Comment

Readers' comments (1)

  • The Article 'Using compliments to measure quality' says that the DH was offering guidance for trusts on producing patient information leaflets on the four C's - comment, concern, complaint or compliment. Might I suggest that the latter be further sub-divided with 2 more C's - Chocolates and Cream Cakes! Unfortunately these two items don't last long enough to make it into the statistics! As a team of Clinic based, wound care community nurses, we get our fair share of compliments, but on a personal level, the biggest compliment I've received, is when a patient returned after her mastectomy to thank me for the hug that helped see her through! I know that, strictly speaking 'hugs' are not allowed anymore - but sometimes you just know when one is called for!

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